New Guidelines For Treating Carpal Tunnel Syndrome

Evidence-based guidelines recommend conservative treatment for CTS
Carpal tunnel syndrome (CTS) is due to a build up of pressure around the median nerve as it passes through the carpal tunnel at the front of the wrist, leading to sensory and motor changes in the tissue that is supplied by the nerve. According to the American Academy of Orthopaedic Surgeons (AAOS), the incidence of carpal tunnel syndrome in the U.S. has been estimated at about 50 cases per 1,000 people in the general population. A study released by the National Center for Health Statistics estimated that 3.1 million people sought help from physicians for the treatment of carpal tunnel syndrome in 2005.

CTS has classically been thought of as a surgical condition. The carpal tunnel is surrounded by 8 bones at the back and a ligament at the front and has 8 tendons as well as the median nerve running through it. Things can get a bit cramped, and this puts pressure on the nerve. Although releasing the ligament at the front will release pressure on the nerve, other contributing factors should be assessed and treated prior to surgery. While your carpal tunnel now may have more space and the nerve is no longer so compressed, it is VERY likely the carpal tunnel wasn’t the spot where symptoms were coming from. Many people experience a decrease in symptoms for some period of time, weeks or a year or more. And then the symptoms come back.
For example, soft tissue thickening can also increase pressure on the median nerve. The nerve is a dynamic structure—It is like a superhighway carrying not only nerve impulses but also nutrients and waste products along with its length. Pressure on the nerve restricts the transport of nutrients and waste and increases the nerve’s sensitivity—you feel pain, pins & needles & numbness more easily. Thus it is essential to assess the neck and the whole pathway that the median nerve travels from the neck to the hand.
In October 2008, the AAOS released evidence-based clinical practice guidelines for the treatment of carpal tunnel syndrome. Dr. Michael W. Keith, who chaired the writing committee that developed the guidelines, says there are many options for physicians to consider when managing patients with carpal tunnel syndrome.

It’s imperative that physicians have information about the different techniques available for performing carpal tunnel release. In many cases, surgery is not the only treatment option. The AAOS finds that the literature supports the use of conservative techniques, which achieve similar clinical outcomes.

Another pilot study comparing two manual therapy interventions for carpal tunnel syndrome appearing in the Journal of Manipulative and Physiological Therapeutics (2007) presented data that substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS.
Current evidence suggests that conservative treatment, including Airrosti skilled manual therapy, is key to preventing carpal tunnel syndrome as well as for the successful recovery and long-term relief of existing carpal tunnel symptoms.
It’s best to always try conservative therapy first and eliminate future injections and surgical procedures. Airrosti’s doctors take time to diagnose the root of the pain, which may not actually be the carpal tunnel at all, and then use a hands-on approach to fix the pain. They also prescribe at-home care and stretching routines as needed to speed up the healing process. This technique often leaves patients pain-free in an average of three visits.

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